- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $4,261.00 / $12,154.00
| Facility | | $1,110.00 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $4,344.00 / $10,043.00
| Facility | | $2,232.00 | $4,344.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.48 / $588.26 / $2,666.00
| Facility | | $382.48 | $588.26 | $2,666.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,874.00 / $5,813.00
| Facility | | $1,438.00 | $2,874.00 | $5,813.00 |